Determination of Factors Affecting the Isolation of Candida Species Among Diabetic Patients with Oral Candidiasis in Duhok Governorate, Iraq

Dialysis patients, often immunocompromised, are highly susceptible to infectious diseases, including oral candidiasis, the most common mycotic infection of the oral mucosa. To identify risk factors for oral candidiasis in dialysis patients to improve management strategies. A cross-sectional study was conducted in Birjand, Iran, involving 158 dialysis patients. Oral samples were cultured on CHROMagar Candida medium, with Candida species identified using colony color and molecular techniques. Multiple logistic regression analysis was used to determine predictors of oral candidiasis. Of the 158 patients, 69 (43.7%) tested positive for oral candidiasis, yielding 97 Candida isolates. Candida albicans was the most prevalent species (55.7%), followed by Candida glabrata (22.7%). Significant predictors of oral candidiasis included longer dialysis duration (OR = 7.48; 95% CI = 1.31-2.05; p < 0.001), male gender (OR = 3.07; 95% CI = 1.12-8.39; p = 0.02), and smoking (OR = 7.48; 95% CI = 1.98-28.31; p = 0.003). Oral candidiasis is a prevalent opportunistic infection in dialysis patients, particularly among men, smokers, and those with extended dialysis duration. Enhanced screening, especially in developing countries, may be useful to address this often-overlooked condition.

Background: Oral candidiasis is an infection that follows colonization of oral cavity by Candida species mostly Candida albicans. About 90% of HIV-infected persons develop this disease during the course of HIV infection and could serve as early sign of HIV-related immunodeficiency. Treatment involves the use of antifungal drugs. The objectives of this study are to determine the prevalence of oral candidiasis and the susceptibility of isolated Candida species to available antifungal agents among selected HIV-infected patients in a mission hospital, southeast Nigeria.&#x0D; Methodology: This was a descriptive cross-sectional study of 150 consecutively selected HIV-infected patients attending the Heart-to-Heart clinic of Iyi-Enu mission hospital Ogidi, Anambra State, Nigeria, between December 2022 and February 2023. Demographic information of each participant was obtained using structured questionnaire. Five milliliters of whole blood were drawn from the antecubital vein of each participant for CD4+ estimation. Mouth specimens were collected using two sterile cotton swabs for microscopy and culture on Sabouraud Dextrose Agar, and Candida species were identified after subculture on CHROMAgar. Antifungal susceptibility testing was performed by Kirby-Bauer disk diffusion method using fluconazole, clotrimazole, ketoconazole, and nystatin disks, and results interpreted according to the guidelines of the Clinical and Laboratory Standards Institute.&#x0D; Results: A total of 98 (65.3%) HIV-infected participants were positive for oral candidiasis, with 4 species of Candida isolated; Candida albicans (62.2%), Candida glabrata (18.4%), Candida tropicalis (12.2%) and Candida krusei (7.1%). Fifty-nine (60.2%) of the 98 participants had CD4+ cell count ˂ 200, 33 (33.7%) had counts in the range of 200-399, and 6 (6.1%) had counts in the range of 400-499 cells/μL (p=0.001). The prevalence of candi- diasis was not significantly different between the female (67.0%, 65/97) and male (62.3%, 33/53) participants (p=0.6598), but the prevalence was significantly higher (p&lt;0.05) in participants age group 21-30 years (80.7%, 42/52), divorced (100%, 1/1) and married (75%, 45/60), those with primary school level education (73.7%, 42/57), civil servants (85.7%, 18/21), and those who performed mouth hygiene once daily (71.9%, 69/96). Nystatin (77.6%, 76/98) showed the highest while fluconazole and ketoconazole (68.4%, 62/98) showed the lowest in vitro antifungal activity&#x0D; Conclusion: Oral candidiasis is prevalent among HIV-infected patients in the study population, with evidence of in vitro resistance of the Candida isolates to available antifungal drugs. Proper diagnosis, susceptibility testing and treatment of infection will be helpful in managing oral candidiasis infection among HIV infected patients.

The study aimed to fill the knowledge gap regarding the prevalence of Candida infections in diabetic patients and their sensitivity to antifungal drugs. Clinical samples from diabetic patients were collected at Yaoundé Central Hospital and Candida species identified. The ability of these species to form biofilms was assessed, and their susceptibility to usual antifungal drugs, as well as some plant extracts and fractions, was determined. Mycological diagnosis was performed on the collected samples. The Candida species isolated and identified were subjected to the crystal violet assay in a microtiter plate to examine their biofilm-forming abilities. The disk diffusion method was used for susceptibility testing for reference antifungals, while the broth dilution method was employed for plant extracts and fractions. These were obtained from the leaves of Picralima nitida, Phragmanthera capitata, and Spondia cythereae, and the roots and fruits of Garcinia Kola. The study found that 43.18% of the 396 collected samples were colonized by various Candida species, including Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, Candida krusei, Candida guillermondii, Candida lusitaniae, and Candida ciferrii. Biofilm production was observed in 46.04% of the isolates, with non-albicans Candida species showing a higher rate than Candida albicans. The isolates exhibited high resistance to nystatin and ketoconazole, dose-dependent sensitivity to miconazole, and sensitivity to econazole and fluconazole. Multidrug resistance was observed in 24.75% of the isolates. While none of the crude extracts showed activity against the tested Candida, six out of 25 fractions (PnlB, PclA, PclW, SclA, SclW, and GkfW) displayed fungistatic activities on some strains. These findings offer valuable insights into the prevalence and antifungal resistance patterns of Candida species in diabetic patients in Cameroon. They also suggest the potential for alternative treatments using plant fractions.

IntroductionOral candidiasis is one of the most common opportunistic infection in HIV/AIDS patient and it is caused by Candida species. The low absolute CD4+T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of Oral Candidiasis. The aim of this study was to identify Candida species isolated from the oral cavity of HIV/AIDS patients, to determine their in vitro antifungal susceptibility and to investigate the possible risk factors associated with oral candidiasis.MethodsThis was a hospital based cross sectional study that was carried out for a period of 3 months amongst HIV/AIDS patients in Kumba District Hospital, whether on HAART or not. Mouth swabs were collected from 378 participants using sterile cotton wool swabs and 5ml venous blood were collected for determination of CD4 cell. Candida species were isolated and identified. Antifungal sensitivity testing was performed using modified kirby-bauer susceptibility testing technique.ResultsCandida species were present in 42.86% of the samples and Candida albicans was the most prevalent (60.2%) amongst the six Candida isolates identified, followed by Candida glabrata (16.9%), Candida krusei (12.3%), Candida tropicalis (6.4%), Candida parapsilosis (2.3%) and Candida pseudotropicalis (1.8%). Pregnancy, oral hygiene and antibiotic usage were significantly associated with oral candidiasis in HIV/AIDS patients (P<0.05). Oral candidiasis was mostly frequent in HIV/AIDS patients between 21-40 years. A CD4 cell count less than 200 cells/μl was a significant risk factor for acquiring oral candidiasis in HIV/AIDS patients (P<0.001). Nystatin was the most sensitive drug (83.6%) meanwhile ketonazole was the most resistant drug (29.2%), followed by fluconazole (24.6%) to all oral Candida isolates.ConclusionOral Candida colonization occurs more frequently in HIV/AIDS patients and the is a need for the government to implement regular checks for opportunistic infections in HIV/AIDS patients, including oral candidiasis in HIV/AIDS patients to monitor disease progression and prevent subsequent complications such as candidemia and diarrhea.

Background: Oral candidiasis is a prevalent opportunistic infection, predominantly caused by Candida albicans (CA), though non-albicans Candida (NAC) species are increasing worldwide. This study aimed to characterize the prevalence of Candida species, evaluate antifungal susceptibility, and identify predisposing risk factors in patients with oral mucosal candidiasis. Methods: A retrospective review of 1286 electronic patient medical records (788 women, 498 men) from 2018 to 2022 was conducted at the Department of Periodontal and Oral Mucosa Diseases, Medical University of Silesia. Swabs from the oral cavity were processed to identify Candida strains by mass spectrometry, followed by drug susceptibility testing for amphotericin B, nystatin, flucytosine, econazole, ketoconazole, miconazole, and fluconazole. Relevant local and systemic predisposing factors were recorded and analyzed statistically. Results: Among 958 patients with positive fungal cultures, CA accounted for 66.79% of isolates, while NAC constituted 33.21%. Multi-strain infections were detected in 8.46% of patients. CA showed lower resistance (<10%) to amphotericin B, nystatin, and flucytosine, but up to 30% resistance to azoles. NAC strains demonstrated elevated resistance rates (>40% for most azoles), with C. krusei exhibiting the highest resistance to the previously mentioned antifungal agents. Key risk factors included wearing removable dentures (p = 0.042) and uncontrolled diabetes mellitus (p = 0.0431). Additional factors, including poor oral hygiene, reduced salivary flow, and immunosuppressive conditions, further increased infection risk. Patients presenting with multiple risk factors were more likely to have multi-strain infections and more severe disease courses. Conclusions: This retrospective analysis highlights the growing prevalence of NAC, rising antifungal resistance (particularly to azoles), and the importance of identifying risk factors, especially denture use and poor glycemic control. Enhanced preventive strategies, robust diagnostic approaches, and optimized antifungal regimens are essential to address this evolving clinical challenge.

Background Candiduria, defined as the presence of Candida in urine, can indicate asymptomatic colonization or an active urinary tract infection. In individuals with risk factors such as diabetes mellitus, this condition can lead to complications like fungal pyelonephritis and disseminated candidiasis. Chronic hyperglycemia weakens immune response, promotes fungal proliferation, and creates a favorable environment for Candida adhesion to the urothelium. This study analyzes the prevalence of Candida urinary tract infections in diabetic patients, evaluating its relationship with hyperglycemia and comparing findings with existing literature. Methods This is an epidemiological, cross-sectional study based on a laboratory database from a private lab in Fortaleza, Brazil. Urinalysis and fungal culture results from patients between January 2022 and February 2025 were evaluated. Parameters analyzed included leukocyturia and Candida colony counts (CFU/mL), along with species identification by Vitek 2 Compact and its association with diabetes. Results A total of 112,506 urine cultures were analyzed, of which 201 (0.18%) showed Candida growth. Among these, 43.7% (N=88) were diabetic patients, suggesting a significant prevalence of infection in this population. Among diabetics with Candida, 70% (N=62) were women. The most prevalent species was Candida glabrata, isolated in 43.3% (N=87) of the positive samples, with 60.9% (N=53) of these cases occurring in diabetics. Candida albicans was the second most common species, accounting for 29.3% (N=59) of the cases, but with a lower association with diabetes (30.5% (N=18) of cases). Candida tropicalis was identified in 12.9% (N=26) of the positive samples, with 38.5% (N=10) occurring in diabetics. The analysis of Candida colony counts at different CFU/mL concentrations revealed that 32% of diabetic patients presented fungal growth above 100,000 CFU/mL, whereas this high fungal load was observed in only 20% of non-diabetic patients. At intermediate concentrations (∼50,000 to ∼80,000 CFU/mL), there was no significant variation between the groups. Leukocyturia showed no significant difference between diabetic and non-diabetic patients infected with Candida. Only 12% of the diabetic population with Candida had positive leukocyturia, compared to 18% of non-diabetics, suggesting that the urinary inflammatory response may not be directly associated with the presence of the fungus. Conclusion The results indicate a strong association between diabetes and increased Candida presence in urine, with a higher prevalence among diabetic patients, particularly women. Candida glabrata was the most frequent species and strongly associated with diabetes, while Candida albicans showed lower prevalence. Fungal load was significantly higher in diabetics at concentrations above 100,000 CFU/mL, suggesting an impact of hyperglycemia on fungal proliferation. However, leukocyturia showed no significant differences, indicating that urinary inflammation may not be directly related to Candida infection in diabetics. These findings highlight the importance of microbiological surveillance in diabetic patients for early Candida detection, enabling proper clinical management and preventing complications. Reviewing existing literature is crucial to corroborate these findings and deepen understanding of the mechanisms linking diabetes and fungal urinary infections.

Aim: The goals of this study were: 1) to estimate the prevalence of oral candidiasis (OC) in a sample of Brazilian HIV-infected adult patients, and 2) to investigate the risk factors for HIVassociated OC in this sample. Methods: This case-control study included 112 HIV-infected patients treated between 2002 and 2004 at a clinic for sexually transmitted diseases. Data were collected from medical records and clinical examinations. Diagnosis of OC was performed in accordance with the International Classification System and cytological features. Seventeen clinical and laboratorial variables were registered. Univariate analyses were performed on all variables. Multiple logistic regression techniques were used to develop a model and identify the set of variables that may predict risk factors in HIV-infected adult patients with OC. Results: Prevalence of OC was 31.3%. OC was associated with oral hairy leukoplakia (OHL) [p<0.001; odds ratio (OR) = 10.2 (95%CI: 4.0-26.0)], previous use of fluconazole [p<0.001; OR=27.4 (95%CI: 8.1-92.0)] and viral load [p=0.042; OR=2.3 (95%CI: 1.0-5.3)]. Conclusions: These results are important for the development of strategies to eliminate these risk factors and significantly reduce OC in HIV-infected patients.

Background:Oral candidiasis is a common opportunistic infection in diabetic patients. Presence of denture in the oral cavity of diabetic patients can promote Candida colonization and results in the higher incidence of oral and systemic candidiasis. The general purpose of the present study was to evaluate and compare Candida colonization in denture of diabetic patients and non-diabetic control group.Methods:In current case-control study, samples for mycological examinations were collected from the palatal impression surface of maxillary dentures from 92 edentulous patients including 46 dia-betic and 46 non-diabetic denture wearers. All samples were cultured directly on sabouraud agar me-dium and isolated colonies were counted and identified based on specific tests. Data were statistically analyzed using Mann-Whitney and Spearman correlation tests.Results:The higher density of isolated colonies was seen in diabetic group in compare with control group (P = 0.0001). There was a statistically significant correlation between the blood glucose level (P = 0.0001) and the duration of denture usage (P = 0.022) with the colonization of Candida on denture of diabetic patients. C. albicans was the most common isolated Candida species in both groups, though diabetic patients with dentures had more non-albicans Candida isolated from their dentures compared to non-diabetic patients.Conclusions:Mycological findings from the present study revealed that diabetes mellitus can in-crease colonization of Candida in denture and mouth. By elimination of local and systemic factors in diabetic patients and improving their oral health care, Candida colonization and the risk of oral and systemic candidiasis will be decreased.

The present retrospective multicenter study intended to investigate the factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas. A total of 326 patients who underwent radiotherapy for oral and oropharyngeal cancers were enrolled in the study. The patients' age, sex, body mass index, primary site, diabetes, serum albumin, creatinine, hemoglobin, leukocyte and lymphocyte, concurrent cisplatin or cetuximab, method of radiation, total radiation dose, feeding route, use of spacers, pilocarpine hydrochloride, and corticosteroid ointment were examined, and the associations of each variable with oral mucositis and candidiasis were analyzed by multivariate Cox regression analysis. Grade 3 oral mucositis occurred in 136 (41.7%) patients. Male sex, oropharyngeal cancer, low hemoglobin levels, low leukocytes or lymphocytes, concurrent cisplatin or cetuximab, and oral feeding were found to be significantly associated with a higher incidence of severe oral mucositis. Oral candidiasis occurred in 101 (31.0%) patients. Oropharyngeal cancer, low leukocyte count, and oral mucositis of grade 2 or higher were found to be significantly associated with a higher incidence of oral candidiasis. The use of a topical steroid ointment was not found to be a risk factor for oral candidiasis. The present retrospective study demonstrated that certain factors may predispose patients with oral and oropharyngeal cancers receiving radiotherapy to develop severe oral mucositis and oral candidiasis. A preventive strategy for severe oral mucositis needs to be established in the future for high-risk cases.

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.

Introduction: Tooth extraction can lead to several complications; therefore, it is essential to assess the patient's condition to prevent potential complications carefully. Candida infection is one type of complication triggered by tooth extraction. Oral candidiasis is a common fungal infection in humans caused by the overgrowth of Candida albicans, the primary etiological agent. Tooth extraction can increase a person's risk of developing oral candidiasis due to environmental changes in the oral cavity that can increase fungal growth so that the post-extraction wound area becomes prone to candida infection. This scoping review aims to analyze risk factors for oral candidiasis in patients after tooth extraction. Methods: The writing followed the PRISMA-ScR guidelines. Articles are searched using electronic databases, namely PubMed, ScienceDirect, and Elsevier. The population in this review was patients diagnosed with oral candidiasis after tooth extraction. Full-text journals in English published from 2013 to 2023 non-literature review research method. Results: Seven articles were obtained that met the inclusion criteria. The study design used, namely 2 experimental articles and 5 case report articles, showed the occurrence of oral candidiasis after tooth extraction due to immunocompromised conditions which caused the body to experience decreased immunity, causing a delay in the wound healing process and failure to fight Candida infection. Positive fungal culture results for Candida spp. confirmed the diagnosis of oral candidiasis. Conclusion: The act of tooth extraction increases the risk of oral candidiasis, which is triggered by the patient's underlying condition, rendering the commensal fungus Candida albicans pathogenic. This is proven based on research findings in the last 10 years, post-extraction oral candidiasis occurs, accompanied by Immunocompromised conditions such as diabetes, HIV, grave diseases, hypertensive conditions, and also found due to abuse of heroin, opioids, and marijuana. Keywords: teeth extraction, oral candidiasis, Candida Albicans, delayed wound healing.

Aim: The objective of the present study was to assess the preventive and therapeutic efficacy of Cervitec Plus against four Candida species grown on acrylic surfaces. Oral candidiasis is a common opportunistic infection due to fungal adherence to acrylic surfaces. Denture wearing patients have increased risk to candidal infection. Chlorhexidine containing antimicrobials are important for prevention and treatment of oral candidal infections. Methods: The preventive and therapeutic antifungal effect of Cervitec Plus varnish compared with chlorohexidene mouth rinse was examined on artificial biofilm of Candida albicans, Candida parapsilosis, Candida tropicalis and Candida glabrata. Nystatin was used as a positive control and Cervitec placebo varnish and sterile saline solution as negative controls. Phase one investigated the therapeutic effect and phase 2 the preventive effects of these agents. Candida biofilms were grown in Sabouraud liquid medium, after being treated by the antifungals and controls. In phase 2 the agents were applied to the wells of the plates and the artificial biofilms were then grown. To determine the metabolic activity of biofilms XTT-assay were used. The tests were performed in triplicate. Results: In the therapeutic phase (1), Cervitec Plus varnish did not reduce the CFU of the candida species more than the generally used antimicrobials. The most effective therapeutic agent was Chlorohexidene, followed by Nystatin and Cervitec Plus. In phase 2 the most effective preventive agent against Candida albicans and Candida parapsilosis was the Nystatine and Cervitec Plus, followed by Chlorohexidene. In the case of Candida tropicalis and glabrata, the Nystatin was more effective, compared to Cervitec Plus and Chlorohexidene. Discussion: According to our findings, the therapeutic efficacy of Cervitec Plus is no greater than the other studied agents. A preventive effect of Cervitec Plus against Candida albicans and Candida parapsilosis was shown. Because of side-effects of Nystatin, Cervitec Plus may be considered an alternative preventive agent against Candida species. Further study is required to investigate the long-term anticandidal effect of Cervitec.

Candida species is observed as the most common cause of 'Opportunistic Mycoses' worldwide. Candida species is a member of normal flora of skin, mouth, vagina, and stool. Infections caused by Candida species are in general referred to as Candidiasis. Vaginal Candidiasis is a fungal or yeast infection of the vulva and/or vagina, which causes a smelly, thick, white-yellow discharge, which might be accompanied by itching, burning and swelling. It can also can make walking, urinating or sex very painful. The Genus Candida includes around 154 species. While Candida albicans is the most abundant and significant species; importantly, there has been a recent increase in infections due to non-albicans Candida species along with increasing drug resistance. The present study includes isolation of Candida species from the patients suffering from vaginal candidiasis followed by identification and differentiation between different Candida species by their morphological studies, microbiological analysis and biochemical activities, which are: C. albicans, C. tropicalis, C. glabrata & C. krusei. The present study also includes a comparative study of anti-microbial activities of commercially available anti-fungal drugs as well as 22 novel chemically synthesized 1% DMSO soluble compounds (belonging to Azoles) by “Disc Diffusion Method” according to NCCLS Guidelines. Out of which 5 compounds were found to be remarkably effective, especially AntiC-15 was found to be the most potent and excellent among all; which exhibits its inhibitory effects against some drug resistant isolates also. It is sent for further study in order to use it at commercial level. INTRODUCTION Candida species is yeast and the most common cause of opportunistic mycoses worldwide. It is also a frequent colonizer of human skin and mucous membranes. Candida species is a member of normal flora of skin, mouth, vagina, and stool. Infections caused by Candida species are in general referred to as Candidiasis. The clinical spectrum of Candidiasis is extremely diverse. Almost any organ or system in the body can be affected. Candidiasis may be superficial and local or deep-seated and disseminated. Candidiasis is mostly an endogenous infection, arising from overgrowth of the fungus inhabiting in the normal flora. However, it may occasionally be acquired from exogenous sources such as catheters or prosthetic devices or by personto-person transmission such as Oral Candidiasis in neonates of mothers with Vaginal Candidiasis or Endophthalmitis following corneal transplantation from an infected donor. Vaginal Candidiasis is a fungal or yeast infection of the vulva and/or vagina. It causes a smelly, thick, white-yellow discharge that might be accompanied by itching, burning and swelling. It can also can make walking, urinating or sex very painful. The Genus Candida includes around 154 species. Among these, very few are most frequently isolated in human infections. While Candida albicans is the most pathogenic and most commonly encountered species among all due to its ability to adhere to host tissues, produce aspartyl Effects of chemically synthesized Azole compounds on Clinical isolates of Vaginal Candidiasis, in comparison with commercially available anti-fungal drugs 2 of 6 proteases & phospholipase enzymes and transformation from yeast to hyphal phase, which are the major determinants of its pathogenicity. Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei and Candida lusitaniae are also isolated as causative agents of Candidiasis. Importantly, there has been a recent increase in infections due to non-albicans Candida species along with increasing drug resistance. For the same, the present study also includes a comparative study of anti-microbial activities of commercially available anti-fungal drugs as well as 22 newer chemically synthesized 1% DMSO soluble compounds (belonging to Azoles). MATERIAL & METHODS STUDY GROUP The study group includes different patients suffering from Vaginal Candidiasis with varying degree of severity. SPECIMEN COLLECTION: Vaginal Swab

Oral candidiasis is a common opportunistic oral infection in humans caused by overgrowth of Candida species, in particular Candida albicans. Clinically it usually presents as pseudomembranous or erythematous candidiasis. It may be asymptomatic or associated with local discomfort, dysgeusia and xerostomia. The most common risk factors for oral candidiasis include treatment with antibiotics, poor oral hygiene, tobacco smoking, denture wearing and salivary gland hypofunction. A large number of diseases as well as their treatment including diabetes, cancer and cancer therapy, HIV infection and treatment with immunosuppressants are associated with oral candidiasis. In immunocompromised patients, the localized oral infection can spread through the bloodstream or upper gastrointestinal tract leading to severe infection with increased morbidity and mortality. This chapter focuses on Candida as commensal oral microorganism, the clinicopathological aspects in medically compromised patients and diagnostic methods available regarding oral candidiasis.

Both aspiration pneumonia and oral candidiasis are caused by opportunistic infection of intraoral commensals and have many similar risk factors linked to oral health in older adults. Candida albicans forms biofilms with respiratory bacteria such as Klebsiella pneumoniae and Pseudomonas aeruginosa. The aim of our study was to determine the relationship between bacterial pneumonia, including aspiration pneumonia, and oral candidiasis in older patients who were hospitalized with several systemic diseases in a community-based acute care hospital without a dental unit. We retrospectively analyzed 228 older patients (male: 105, female: 123) using multiple logistic regression. The mean age of the patients was 81.3 (SD: 11.1) years. Forty-four patients were oral candidiasis positive, and 78 patients suffered from bacterial pneumonia, including aspiration pneumonia. Results showed that bacterial pneumonia had the strongest statistical relationship with oral candidiasis (p=0.000, OR: 5.173, 95 % CI: 2.368–11.298). This was followed by poor oral hygiene (p=0.001, OR: 6.095, 95 % CI: 2.003–18.545) and severe dry mouth (p=0.043, OR: 2.507, 95 % CI: 1.031–6.098). Other conventional risk factors for oral candidiasis, such as diabetes mellitus, denture wearer, dysphagia, malnutrition, requiring care, use of inhalation steroids, were not statistically significant in this study. Fifteen species of bacteria, including Klebsiella pneumoniae and Pseudomonas aeruginosa, were detected by pharyngeal sputum culture in 24 of 31 patients who were diagnosed with both oral candidiasis and bacterial pneumonia. In conclusion, bacterial pneumonia is a possible new risk factor for oral candidiasis in older adults.